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MD Anderson: Post-Chemo/Radiation Appointments

It’s been a busy and productive day — as it always is when we come to MD Anderson.

Dr. Sarah DeSnyder

We started the day with an appointment with Dr. DeSnyder (formerly Dr. Gainer), my breast surgeon. Excitingly, she walked in with a big pregnant belly. She is expecting in November.

Our main purpose was to discuss the prophylactic mastectomy on my left side.

I asked her about what Dr. Razaq and Dr. Hermann told us about lobularcancer having a higher chance of mirroring on the opposite side. She agreed. She said it is a .5- to 1-percent cumulative chance for every year that passes. For those of you who aren’t math whizzes, that is about a 2.5- to 5-percent chance that it will show up in five years, and a 10- to 20-percent chance that it will rear its ugly head in 20 years.

I don’t want to do chemo again. I really don’t want to.

She also confirmed that lobular cancer is hard to pick up on a regular mammogram screening.

Those things combined, she said that she thinks I’m making a logical decision to have this done. She supports it. We will do this surgery at the same time as my reconstruction surgery.

We talked about my options for this surgery. I’m not sure if this is the best forum for the details of each option, but the option I am going with is an intricate surgery. Just Dr. DeSnyder’s part alone will be four hours – and that is just to remove the breast tissue. We will not have even started on Dr. Kronowitz’s reconstruction of both sides.

Dr. Steven Kronowitz

Next, we headed to see Dr. Kronowitz, my plastic surgeon, for a reconstruction plan. Our favorite person, his physician assistant Katie (Kathryn Awalt), was not there today, which stinks. She balances out his rock-star presence — the one where he blazes in, spouts out a bunch of things and blazes out. She usually helps us translate.

With this, they use muscle, skin and fat from my back (shoulder blade area) and swing it around to the front. He attaches it in the front and puts in an implant underneath that muscle. I will be left with a scar on my back.

On the left side, he will put an implant or a tissue expander in, depending on how my skin is looking after Dr. DeSnyder is done with her part. If the blood flow is looking good, they will use an implant. If not, they will use an expander (to be switched out with an implant in a later surgery) so the skin isn’t stretched too much. It will be a call they make during surgery.

He wants to do surgery in about three months. This is puts us in mid-December. We figured we’d be bumped into January due to the holidays which was fine with us. After leaving his office though, we found out that Dr. DeSnyder will not return from maternity leave until mid-February, which puts us at five months from the end of radiation. Dr. Kronowitz had said he doesn’t want to go any longer than six months or the skin begins to contract.

I’m torn. I don’t like the idea of a different surgeon doing the mastectomy. I’d rather wait for her to get back, quite frankly. But that’s just more waiting.

We are currently at the mercy of the patient schedulers to work all of this out.

From there, we had a blood test – the first one since chemo ended. Everything looked good.

After lunch, we headed for a mammogram on my left side. Just my annual checkup. I was able to get results really quickly — everything looks normal. Woo hoo!

Dr. Stacy Moulder

We ended the day with Dr. Moulder, my oncologist.

One of the things my OU oncologist has recommended was either giving me an injection in my ovaries that will “put them to sleep” or removing them altogether. Instead of Tamoxifen, she would give me a different medication that is intended for women who are post-menopausal. She showed us how this could lower my recurrence percentages a bit.

This seemed very extreme to me, so I was anxious to get a second opinion with Dr. Moulder. As I suspected, Dr. Moulder disagreed with this approach. She does not recommend removing them because it does not show to reduce my chances of recurrence. As far as “putting them to sleep” goes, she says studies are coming in that show that this is often less effective than Tamoxifen.

So, I’ve got some thinking to do with that information.

Under Dr. Moulder’s plan, I would meet with her every three months for the next year. This is mainly to do a physical examination, looking for recurrence. Ugh — that makes me cringe.

I have to decide whether I will do that with her or with Dr. Razaq (the OU oncologist) or, as she suggested, a combination of both of them.

So, we will wait for the schedulers to coordinate for a surgery date. I’m anxious to get that date on the calendar. I need these milestones.

I tried to pin Dr. Kronowitz down on a timeframe in which I can say I am done with surgeries. He wouldn’t commit. He said it all depends on how the first surgery goes and what follow-up surgeries I will require. He did throw in that he likes to wait about six months between surgeries. That automatically puts us at June 2014 if I have to have a follow-up surgery to switch out the plastic expander for an implant on my left side, for instance.

All in all, we are really encouraged by this visit. It always feels like our days are packed with appointments and we make progress.